PUK11 Preliminary Cost-Minimization Analysis of Continuous Versus Intermittent Renal Replacement Therapy in Intensive Care Patients Experiencing Acute Renal Failure

Abstract

To compare 1-year treatment cost of initial continuous renal replacement therapy (CRRT) vs. intermittent daily hemodialysis (IHD) or slow extended daily dialysis (SLEDD) in critically ill patients with acute renal failure in Germany. As differences in hospital survival rates among the evaluated renal replacement therapies (RRT) are not evident, a cost-minimization model was developed to compute potential direct medical costs associated with dialysis for each treatment group. The preliminary analysis has been performed from the perspective of the German statutory health insurance. Model input data was derived from published literature and complemented by expert opinion in case of missing information. Total estimated average per-patient hospital costs were found to be similar for the evaluated hypothetical RRT cohorts, amounting to €12,380 for CCRT, €12,650 for IHD, and €12,528 for SLEDD. Whereas costs of disposables are substantially higher for CRRT than for IHD/SLEDD, these incremental costs were largely offset by an expected average ICU stay reduction of one day owing to assumed minor treatment benefits for CRRT. As sufficiently powered, randomized comparative trials are currently lacking, we assumed equivalent hospital mortality for each analyzed RRT treatment group as shown in meta-analyses, but a slightly higher renal recovery rate at discharge for CRRT than for IHD/SLEDD (87.8% vs. 80.0%) as indicated by several studies. Consequently, follow-up costs involving chronic RRT in survivors remaining dialysis dependent after discharge were lower for CRRT than for IHD/SLEDD resulting in total first year average per-patient costs of €14,020 vs. €16,527/€16,374, respectively. Findings from multivariate sensitivity analyses support the robustness of these preliminary outcomes. In the absence of published data, our exploratory economic analysis provides first indications of potentially lower total first-year costs for initial CRRT than for IHD/SLEDD. To corroborate these findings, supplementary and consistent clinical and resource use data is warranted.